USPSTF recommends intensive behavioral counseling for overweight, obese adults with additional CVD risk factors

The U.S. Preventive Services Task Force (USPSTF) announced an update and refinement of its 2003 recommendation on dietary counseling for adults with risk factors for cardiovascular disease (CVD).

The USPSTF based its current recommendation on a systematic review of the literature, which looked at the benefits and harms of lifestyle counseling interventions in adults with CVD risk factors. The review included literature published from January 2001 to October 2013, a total of 74 trials. Most of the interventions studied in the trials were intensive combined counseling on healthful diet and physical activity involving multiple contacts over extended time periods (average, 5 to 16 contacts over 9 to 12 months). In all but 2 of the included trials, patients' average body mass index exceeded 25 kg/m².

The review found that at 12 to 24 months, intensive lifestyle counseling in patients who were selected for counseling because of risk factors had decreased total cholesterol levels, low-density lipoprotein cholesterol levels, systolic blood pressure, diastolic blood pressure, fasting glucose levels, diabetes incidence, and weight. The trials included in the review did not have many data available on patient health outcomes, harms, or longer-term follow-up, but the authors concluded that intensive behavioral counseling on diet and physical activity consistently improved several important intermediate health outcomes for up to 2 years.

As a result, the USPSTF recommends that clinicians offer intensive behavioral counseling interventions to promote a healthful diet and physical activity to adults who are overweight or obese and have additional factors for CVD, or refer this group to such interventions. This differs slightly from the USPSTF's 2003 recommendation, which recommended intensive behavioral dietary counseling for adult patients with known CVD risk factors. The recommendation applies to adults 18 years of age or older in primary care settings who are overweight or obese and have such additional CVD risk factors as hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome. It is a grade B recommendation, meaning that there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

Both the recommendation and the systematic review were published online Aug. 26 by Annals of Internal Medicine.